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Felix MMR, Kuschnir FC, Boechat JL, Castells M. Recent findings on drug hypersensitivity in children. FRONTIERS IN ALLERGY 2024; 5:1330517. [PMID: 38384771 PMCID: PMC10879301 DOI: 10.3389/falgy.2024.1330517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Drug hypersensitivity reactions (DHR) in children have a significant impact on clinical practice and public health. Both under-diagnosis (due to under-reporting) and over-diagnosis (due to the overuse of the term "allergy") are potential issues. The aim of this narrative review is to describe the most recent findings of DHR in children/adolescents and gaps regarding epidemiology, antibiotic allergy, antiepileptic hypersensitivity, vaccine allergy, and severe cutaneous adverse reactions (SCAR) in this age group.
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Affiliation(s)
- Mara Morelo Rocha Felix
- Department of General Medicine, School of Medicine and Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio Chigres Kuschnir
- Department of Pediatrics, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Laerte Boechat
- Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Castells
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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Sáenz de Santa María R, Bogas G, Labella M, Ariza A, Salas M, Doña I, Torres MJ. Approach for delabeling beta-lactam allergy in children. FRONTIERS IN ALLERGY 2023; 4:1298335. [PMID: 38033918 PMCID: PMC10684789 DOI: 10.3389/falgy.2023.1298335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.
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Affiliation(s)
- R. Sáenz de Santa María
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - G. Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. Labella
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - A. Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. Salas
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - I. Doña
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
| | - M. J. Torres
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
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3
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Nuñez-Borque E, Fernandez-Bravo S, Rodríguez Del Rio P, Palacio-García L, Di Giannatale A, Di Paolo V, Galardi A, Colletti M, Pascucci L, Tome-Amat J, Cuesta-Herranz J, Ibañez-Sandin MD, Laguna JJ, Benito-Martin A, Esteban V. Novel mediator in anaphylaxis: decreased levels of miR-375-3p in serum and within extracellular vesicles of patients. Front Immunol 2023; 14:1209874. [PMID: 37965316 PMCID: PMC10642912 DOI: 10.3389/fimmu.2023.1209874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Anaphylaxis is among the most severe manifestations of allergic disorders, but its molecular basis remains largely unknown and reliable diagnostic markers are not currently available. MicroRNAs (miRNAs) regulate several pathophysiological processes and have been proposed as non-invasive biomarkers. Therefore, this study aims to evaluate their involvement in anaphylactic reaction and their value as biomarkers. Methods Acute (anaphylaxis) and baseline (control) serum samples from 67 patients with anaphylaxis were studied. Among them, 35 were adults with drug-induced anaphylaxis, 13 adults with food-induced anaphylaxis and 19 children with food-induced anaphylaxis. The circulating serum miRNAs profile was characterized by next-generation sequencing (NGS). For this purpose, acute and baseline samples from 5 adults with drug-induced anaphylaxis were used. RNA was extracted, retrotranscribed, sequenced and the readings obtained were mapped to the human database miRBase_20. In addition, a system biology analysis (SBA) was performed with its target genes and revealed pathways related to anaphylactic mediators signaling. Moreover, functional and molecular endothelial permeability assays were conducted with miR-375-3p-transfected cells in response to cAMP. Results A total of 334 miRNAs were identified, of which 21 were significant differentially expressed between both phases. Extracellular vesicles (EVs) were characterized by Western blot, electron microscopy and NanoSight. A decrease of miR-375-3p levels was determined by qPCR in both serum and EVs of patients with anaphylaxis (****p<.0001). Precisely, the decrease of miR-375-3p correlated with the increase of two inflammatory cytokines: monocyte chemoattractant protein-1 (MCP-1) and granulocyte macrophage colony-stimulating factor (GM-CSF). On the other hand, functional and molecular data obtained showed that miR-375-3p partially blocked the endothelial barrier maintenance and stabilization by disassembly of cell-cell junctions exhibiting low Rac1-Cdc42 levels. Discussion These findings demonstrate a differential serum profile of circulating miRNAs in patients with anaphylaxis and exhibit the miR-375-3p modulation in serum and EVs during drug- and food-mediated anaphylactic reactions. Furthermore, the in silico and in vitro studies show a negative role for miR-375-3p/Rac1-Cdc42 in the endothelial barrier stability.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sergio Fernandez-Bravo
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Pablo Rodríguez Del Rio
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Fundación Hospital Niño Jesús (HNJ), Instituto de Investigación del Hospital de La Princesa (IIS-P), Madrid, Spain
| | - Lucia Palacio-García
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Angela Di Giannatale
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Virginia Di Paolo
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Galardi
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Marta Colletti
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luisa Pascucci
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - Jaime Tome-Amat
- Centro de Biotecnología y Genómica de Plantas, Universidad Politécnica de Madrid-Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (UPM-INIA), Universidad Politécnica de Madrid, Madrid, Spain
| | - Javier Cuesta-Herranz
- Department of Allergy. Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María Dolores Ibañez-Sandin
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Fundación Hospital Niño Jesús (HNJ), Instituto de Investigación del Hospital de La Princesa (IIS-P), Madrid, Spain
| | - José Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Cruz Roja Central Hospital, Villanueva de la Cañada, Madrid, Spain
- Faculty of Medicine and Biomedicine, Universidad Alfonso X el Sabio (UAX), Madrid, Spain
| | - Alberto Benito-Martin
- Faculty of Medicine and Biomedicine, Universidad Alfonso X el Sabio (UAX), Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Faculty of Medicine and Biomedicine, Universidad Alfonso X el Sabio (UAX), Madrid, Spain
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Cernadas J, Vasconcelos MJ, Carneiro-Leão L. Desensitization in children allergic to drugs: Indications, protocols, and limits. Pediatr Allergy Immunol 2023; 34:e13965. [PMID: 37366205 DOI: 10.1111/pai.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Any drug can potentially induce a hypersensitivity reaction. If after the allergological work-up the drug hypersensitivity reaction is confirmed, in most cases, the simple avoidance of the culprit drug and a suggestion of an unrelated alternative is enough. However, there are circumstances where the choice to stop the treatment affects the survival, the safety and/or the quality of life of the patient and the global outcome of the disease in question. When this occurs, drug desensitization can be the answer and should not be viewed as an extravagance, nor the pediatric age should be considered a contraindication. Drug desensitization in children can be safely and successfully performed, having a positive impact on the survival and overall prognosis. In general, the indications for DDS are the same in adults as in children. However, in this age group there are specificities that this paper aimed to describe, reviewing the mechanisms behind drug hypersensitivity and rapid drug desensitization, types of protocols, indications, and contraindications, as well as several technical aspects that are specific to the pediatric age.
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Affiliation(s)
- Josefina Cernadas
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
- Unidade de Imunoalergologia, Hospital Lusíadas Porto, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
- Unidade de Imunoalergologia, Hospital Lusíadas Porto, Porto, Portugal
| | - Leonor Carneiro-Leão
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
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Walter C, Neustädter I. [Diagnostics of drug allergies and intolerances]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:364-374. [PMID: 37140635 DOI: 10.1007/s00105-023-05146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The prevalence of hypersensitivity reactions to drugs is increasing. Currently, this affects more than 7% of the world population. Nonsteroidal anti-inflammatory drugs (NSAID) and beta-lactam antibiotics (BLA) are by far the most common pharmaceutical preparations involved in hypersensitivity reactions to drugs. Misdiagnoses are frequent and BLA allergies present a danger that can lead to adverse health outcomes. Therefore, delabeling (exclusion of a suspected diagnosis) is paramount for those affected. Following the occurrence of uncomplicated maculopapular exanthemas, outpatient oral drug provocation can be safely considered in children without prior skin tests. Immediate perioperative reactions are rare. The approach to studying these complex reactions requires collaboration between allergologists and anesthesiologists to provide the best possible care for these patients.
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Affiliation(s)
| | - Irena Neustädter
- Cnopfsche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419, Nürnberg, Deutschland.
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Başkaya N, Ertuğrul A, Esenboğa S, Özmen S. Different age groups present different clinics in anaphylaxis with children: one size does not fit all children. Turk J Med Sci 2023; 53:495-503. [PMID: 37476874 PMCID: PMC10387924 DOI: 10.55730/1300-0144.5609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/13/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Childhood anaphylaxis presents with a heterogeneous clinic. Elicitors and epidemiologic factors associated with anaphylaxis differ with age, geographic location and lifestyle. This study aimed to determine the clinical features and age-specific patterns of childhood anaphylaxis in a single referral center in Turkey. METHODS We conducted a retrospective study of anaphylaxis in children aged between 0 and 18 years of age, attending an allergy department in a children's hospital. RESULTS A total of 95 children diagnosed with anaphylaxis were analyzed. Among all, 35.8% of the first anaphylaxis episodes occurred ininfancy and 57.9% in preschool age. Foods were the most common culprits (57.9%) and followed by drugs (15.8%). Patients with foodinduced anaphylaxis were younger in age (p < 0.001). Food-related anaphylaxis was most common with cow's milk (36.4%) and followed by tree nuts (20%). Cow's milk played a significant role as a trigger in infancy, and tree nuts as a trigger in preschoolers and school-age children. Mucocutaneous manifestations were almost universally present (94.7%), followed by respiratory compromise (56.8%), with gastrointestinal (55.8%), cardiovascular (9.5%), and neurologic (4.2%) symptoms being less common. Respiratory and cardiovascular system-related symptoms were found more frequently in school-age children (p = 0.02 and p = 0.014, respectively). The severity of anaphylaxis was higher in school-age children (p = 0.015). DISCUSSION Findings reveal that children diagnosed with anaphylaxis differ in terms of etiological and clinical findings according to age groups. This difference shows the dynamically changing clinic of anaphylaxis over time and the importance of evaluating childhood anaphylaxis according to age groups.
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Affiliation(s)
- Nevzat Başkaya
- Department of Pediatrics, Division of Allergy and Immunology, University of Health Sciences, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Ayşegül Ertuğrul
- Department of Pediatrics, Division of Allergy and Immunology, University of Health Sciences, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Saliha Esenboğa
- Department of Pediatrics, Division of Allergy and Immunology, University of Health Sciences, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Serap Özmen
- Department of Pediatrics, Division of Allergy and Immunology, University of Health Sciences, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
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Walter C, Neustädter I. Diagnostik von Arzneimittelallergien und -intoleranzen. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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8
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Nuñez-Borque E, Betancor D, Pastor-Vargas C, Fernández-Bravo S, Martin-Blazquez A, Casado-Navarro N, López-Domínguez D, Gómez-López A, Rodriguez Del Rio P, Tramón P, Beitia JM, Moreno-Aguilar C, González-de-Olano D, Goikoetxea MJ, Ibáñez-Sandín MD, Laguna JJ, Cuesta-Herranz J, Esteban V. Personalized diagnostic approach and indirect quantification of extravasation in human anaphylaxis. Allergy 2023; 78:202-213. [PMID: 35841381 PMCID: PMC10087983 DOI: 10.1111/all.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anaphylaxis is the most acute and life-threatening manifestation of allergic disorders. Currently, there is a need to improve its medical management and increase the understanding of its molecular mechanisms. This study aimed to quantify the extravasation underlying human anaphylactic reactions and propose new theragnostic approaches. METHODS Molecular determinations were performed in paired serum samples obtained during the acute phase and at baseline from patients presenting with hypersensitivity reactions. These were classified according to their severity as Grades 1, 2 and 3, the two latter being considered anaphylaxis. Tryptase levels were measured by ImmunoCAP, and serum protein concentration was quantified by Bradford assay. Human serum albumin (HSA) and haemoglobin beta subunit (HBB) levels were determined by Western blot and polyacrylamide gel electrophoresis, respectively. RESULTS A total of 150 patients were included in the study. Of them, 112 had experienced anaphylaxis (83 and 29 with Grade 2 and 3 reactions, respectively). Tryptase diagnostic efficiency substantially improved when considering patients' baseline values (33%-54%) instead of the acute value threshold (21%). Serum protein concentration and HSA significantly decreased in anaphylaxis (p < .0001). HSA levels dropped with the severity of the reaction (6% and 15% for Grade 2 and 3 reactions, respectively). Furthermore, HBB levels increased during the acute phase of all hypersensitivity reactions (p < .0001). CONCLUSIONS For the first time, the extravasation underlying human anaphylaxis has been evaluated based on the severity of the reaction using HSA and protein concentration measurements. Additionally, our findings propose new diagnostic and potential therapeutic approaches for this pathological event.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Diana Betancor
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Department of Allergy, Fundación Jiménez Díaz University Hospital, UAM, Madrid, Spain
| | | | | | | | - Natalia Casado-Navarro
- Department of Clinical Analysis, Fundación Jiménez Díaz University Hospital, UAM, Madrid, Spain
| | - David López-Domínguez
- Clinical Biostatistics Unit, IDIPHIM, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Alicia Gómez-López
- Department of Allergy, Fundación Jiménez Díaz University Hospital, UAM, Madrid, Spain
| | - Pablo Rodriguez Del Rio
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Fundación HNJ, IIS-P, Madrid, Spain
| | - Paloma Tramón
- Department of Clinical Analysis, Fundación Jiménez Díaz University Hospital, UAM, Madrid, Spain
| | | | | | | | | | | | - José Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Madrid, Spain.,Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
| | - Javier Cuesta-Herranz
- Department of Allergy, Fundación Jiménez Díaz University Hospital, UAM, Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
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Süleyman A, Tamay Z, Güler N. Antibiotic allergy in children with cystic fibrosis: A retrospective case-control study. Pediatr Pulmonol 2022; 57:2622-2628. [PMID: 35833362 DOI: 10.1002/ppul.26073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/07/2022]
Abstract
UNLABELLED Antibiotic allergy is a big problem that may affect the treatment and life quality of patients with cystic fibrosis (CF). AIM To evaluate predictive factors for confirmed antibiotic hypersensitivity in children with CF. METHODS In this case-controlled study, we examined 15 patients with CF who had been confirmed with antibiotic allergy. Additionally, we included a control group of age- and gender-matched 45 CF patients with no antibiotic allergy. The diagnosis of antibiotic allergy was confirmed in the presence of a compatible history and a positive response in the drug skin test or provocation test. Multiple drug hypersensitivity was classified according to the temporal relationship of antibiotics: (i) distant, (ii) simultaneous, and (iii) sequential. The data were analyzed by conditional logistic regression. RESULTS β-lactam allergy was confirmed in eight patients (ceftazidime n = 5, piperacillin-tazobactam n = 3) and non-β-lactam allergy was confirmed in two patients (ciprofloxacin n = 1, azithromycin n = 1). Additionally, multiple drug hypersensitivity in five patients (distant n = 4, sequential n = 1), among whom two patients showed hypersensitivity against ceftazidime/piperacillin-tazobactam+ ciprofloxacin/levofloxacin, two patients showed hypersensitivity against ceftazidime+ ciprofloxacin n = 2, and one patient showed hypersensitivity against piperacillin-tazobactam+ amikacin+ trimethoprim-sulfamethoxazole. All patients (n = 13) with confirmed β-lactam allergy were meropenem tolerant. Multivariate analysis indicated that immediate reactions (, p < 0.001) and allergic evaluation in the first six months after the reaction (p = 0.036) were significant risk factors for the prediction of antibiotic hypersensitivity. CONCLUSION Beta-lactam antibiotic allergy is the most commonly confirmed drug allergy in children with CF. However, unlike normal children, ceftazidime and piperacillin-tazobactam account for the majority.
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Affiliation(s)
- Ayşe Süleyman
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Güler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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De-labeling Penicillin Allergy in Pediatric Population. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ren Q, Chen F, Zhang H, Tu J, Xu X, Liu C. Effects of a standardized patient-based simulation in anaphylactic shock management for new graduate nurses. BMC Nurs 2022; 21:209. [PMID: 35915450 PMCID: PMC9341083 DOI: 10.1186/s12912-022-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients may be endangered if new graduate nurses cannot recognize and manage anaphylactic shock. Consequently, enhancing the new graduate nurses’ understanding of their roles and responsibilities during the rescue of a patient with anaphylactic shock is important. However, due to its inherent limitations, traditional classroom-based teaching makes it difficult to explore the potential of the students. Although popular simulation teaching has several notable advantages, it has not been proven to be effective in training inexperienced nurses on anaphylactic shock. We investigated the effect of a standardized patient-based simulation on the behaviors of new graduate nurses’ during anaphylactic shock rescue to identify an effective and safe method for contemporary nursing education. Methods Except for the ill or pregnant, all the new graduate nurses were included in the study as students to undergo a standardized patient-based simulation conducted in the clinical skills center of a general hospital. The simulation training was designed to teach students to recognize the signs and symptoms of anaphylactic shock, place the patient in the correct position, stop the ongoing intravenous infusion of the antibiotic which triggers the anaphylactic shock, restart an intravenous infusion on a new infusion apparatus, give 100% oxygen via a nasal cannula or mask, preserve airway patency, call the rapid response team, and correctly administer the medications prescribed by the clinicians. Before and after the training, the instructors evaluated each student’s skills and behaviors using a clinical competency evaluation list. After the training, all students completed the Chinese version of the Simulation Design Scale (SDS) to demonstrate their satisfaction with the program and then participated in semi-structured interviews with their instructors. Results All 104 graduate nurses had a significant improvement on the 6 competencies of the clinical competency evaluation list after the simulation training (P < 0.001). The SDS scores revealed that the students were highly satisfied with all the aspects of the simulation training (the 20 satisfaction rates were all above 90.00%). During the semi-structured interviews, most of the new graduate nurses reported that simulation training in the management of anaphylactic shock was critical and would guide them in clinical practice. Conclusion Simulation training in anaphylactic shock is a potentially viable and effective method for teaching new graduate nurses to manage clinical incidents.
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Affiliation(s)
- Qi Ren
- Intensive care unit, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Fang Chen
- Nursing department, Zhejiang Hospital, No. 1229 Gudun Road, Zhejiang, Hangzhou, China.
| | - Huijuan Zhang
- Intensive care unit, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Juanhua Tu
- Cardiovascular ward, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Xiaowei Xu
- Gynecology ward, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Caixia Liu
- Nursing department, Zhejiang Hospital, No. 1229 Gudun Road, Zhejiang, Hangzhou, China
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Neonatal medium-sized vessel vasculitis: A rare case report. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Vasculitis is a rare disorder during the neonatal period. We present a term male neonate of consanguineous parents and birthweight of 4 030 g who presented at 11 days of life with an evolving skin rash. There was no history of drug exposure in the neonate except for routine care. On day 7 of life, multiple erythematous plaques with necrotic or pustular centres appeared. There were no signs of mucosal involvement or sepsis and laboratory findings were normal. Skin biopsy revealed small and intermediate vessel vasculitis. At follow-up 2 weeks after discharge from the hospital, the skin lesions persisted, and at age 2 months, the patient presented with features of severe pneumonia and subsequently died. Vasculitis was reported as the cause of death on postmortem biopsy.
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13
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Guðnadóttir GK, Jónasson G, Clausen M, Sørensen TG, Kristjánsson S. Antibiotic oral provocation challenge in children. Acta Paediatr 2022; 111:1056-1060. [PMID: 34878664 DOI: 10.1111/apa.16211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/27/2022]
Abstract
AIM The main objective of this study was to see how many of the children, with a suspected antibiotic allergy, developed an allergic or adverse reaction to a drug provocation test. METHODS Data on children that had undergone a drug provocation test for a suspected antibiotic allergy were compiled retrospectively for the period from 2007-2018. The median age at the first provocation was 2.25 years (1.5-5.7). Standardised questionnaires, the children's parents had answered before the provocation, were used to evaluate the originally suspected allergic reaction, previous health, atopic diseases and family history. RESULTS Ninety-two (6.4%) of the 1440 children showed a possible mild allergic reaction. Sixty-four of the 92 children underwent a second drug provocation test 1-2 years later. At that time, only eleven developed a positive- or a possible-delayed reaction. CONCLUSION An immediate moderate or severe allergic reaction was excluded in all cases of suspected antibiotic allergy in this study. Our study indicates that an oral drug provocation test is safe. It may be appropriate to wait for 6 months or more after the initial event of ADR before these tests are performed. A second oral provocation 1-2 years after the first one shows that ADRs are outgrown in most children.
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Affiliation(s)
| | - Gunnar Jónasson
- University of Iceland Reykjavik Iceland
- Children’s Hospital Iceland Landspítalinn University Hospital Reykjavik Iceland
| | - Michael Clausen
- University of Iceland Reykjavik Iceland
- Children’s Hospital Iceland Landspítalinn University Hospital Reykjavik Iceland
| | | | - Sigurður Kristjánsson
- University of Iceland Reykjavik Iceland
- Children’s Hospital Iceland Landspítalinn University Hospital Reykjavik Iceland
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14
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Ensina LF, Min TK, Félix MMR, de Alcântara CT, Costa C. Acute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management. FRONTIERS IN ALLERGY 2022; 3:840999. [PMID: 35958944 PMCID: PMC9361476 DOI: 10.3389/falgy.2022.840999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Acute urticaria is a common condition that presents with wheals and/or angioedema. However, these symptoms are also frequent in anaphylaxis, a life-threatening reaction that should be immediately diagnosed and treated. In both, mast cells play a central role in the physiopathology. Causes and triggers of acute urticaria and anaphylaxis are similar in general, but some peculiarities can be observed. The diagnostic approach may differ, accordingly to the condition, suspicious causes, age groups and regions. Adrenaline is the first-line treatment for anaphylaxis, but not for acute urticaria, where H1-antihistamines are the first choice. In this paper, we review the main aspects, similarities and differences regarding definitions, mechanisms, causes, diagnosis and treatment of acute urticaria and anaphylaxis.
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Affiliation(s)
- Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
- *Correspondence: Luis Felipe Ensina
| | - Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Mara Morelo Rocha Félix
- Division of Allergy and Immunology, Department of General Medicine, School of Medicine and Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Célia Costa
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitario de Lisboa Norte (CHLN), EPE, Lisbon, Portugal
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15
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SÜLEYMAN A, YÜCEL E, TAMAY Z, GÜLER N. Safety of Cefazolin in Prophylaxis in Β-Lactam Allergic Children. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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16
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Gragnaniello V, Deodato F, Gasperini S, Donati MA, Canessa C, Fecarotta S, Pascarella A, Spadaro G, Concolino D, Burlina A, Parenti G, Strisciuglio P, Fiumara A, Casa RD. Immune responses to alglucosidase in infantile Pompe disease: recommendations from an Italian pediatric expert panel. Ital J Pediatr 2022; 48:41. [PMID: 35248118 PMCID: PMC8898438 DOI: 10.1186/s13052-022-01219-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Classic infantile onset of Pompe disease (c-IOPD) leads to hypotonia and hypertrophic cardiomyopathy within the first days to weeks of life and, without treatment, patients die of cardiorespiratory failure in their first 1–2 years of life. Enzymatic replacement therapy (ERT) with alglucosidase alfa is the only available treatment, but adverse immune reactions can reduce ERT’s effectiveness and safety. It is therefore very important to identify strategies to prevent and manage these complications. Several articles have been written on this disease over the last 10 years, but no univocal indications have been established. Methods Our study presents a review of the current literature on management of immune responses to ERT in c-IOPD as considered by an Italian study group of pediatric metabolists and immunologists in light of our shared patient experience. Results We summarize the protocols for the management of adverse reactions to ERT, analyzing their advantages and disadvantages, and provide expert recommendations for their optimal management, to the best of current knowledge. However, further studies are needed to improve actual management protocols, which still have several limitations.
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17
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Liu X, Gong R, Xin X, Zhao J. Clinical characteristics and allergen detection of perioperative anaphylaxis: a 12-year retrospective analysis from an anesthesia clinic in China. Perioper Med (Lond) 2022; 11:5. [PMID: 35063015 PMCID: PMC8781513 DOI: 10.1186/s13741-021-00234-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Anaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients. Identifying culprit agents responsible for anaphylaxis is of great important for avoiding potential re-exposure to allergens, but it poses great challenge for anesthetists. This retrospective study aimed to analyze the culprits of patients with a history of perioperative anaphylaxis referred to an anesthesia allergy clinic in China, and to evaluate the role of allergy diagnostic tests in clinical practice.
Methods
A total of 145 patients (102 female/43 male) who attended the Anesthesia Allergy Clinic for allergen detection between 1 January 2009 and 31 December 2020 were reviewed retrospectively. Clinical characteristics, results of allergy diagnostic tests including skin, and/or basophil activation tests, and the incidence of repeat anaphylaxis after use of recommended alternative anesthetics were obtained.
Results
Of these 145 patients, 109 patients (75.2%, 74 females/35 males) were determined to experience perioperative anaphylaxis. The most common presenting clinical feature was cardiovascular manifestations (n = 63, 57.8%). According to diagnostic work up, the most common causative agents for perioperative anaphylaxis were neuromuscular blocking agents (n = 35, 32.1%). After diagnostic work up, 52 patients underwent repeat anesthesia. None of these patients experienced recurrent anaphylaxis.
Conclusions
This study suggests that neuromuscular blocking agents are the main cause of perioperative anaphylaxis. For patients with perioperative anaphylaxis, allergy diagnostic tests are essential to identify causative agents, and to find suitable alternative drugs for the future planning of subsequent anesthetics.
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18
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Blanca-Lopez N, Atanaskovic-Markovic M, Gomes ER, Kidon M, Kuyucu S, Mori F, Soyer O, Caubet JC. An EAACI Task Force report on allergy to beta-lactams in children: Clinical entities and diagnostic procedures. Pediatr Allergy Immunol 2021; 32:1426-1436. [PMID: 33931922 DOI: 10.1111/pai.13529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022]
Abstract
Beta-lactam (BL) allergy suspicion is common in children and constitutes a major public health problem, with an impact on patient's health and on medical costs. However, it has been found that most of these reactions are not confirmed by a complete allergic workup. The diagnostic value of the currently available allergy tests has been investigated intensively recently by different groups throughout the world. This has led to major changes in the management of children with a suspected BL allergy. Particularly, it is now well accepted that skin tests can be skipped before the drug provocation test in children with a benign non-immediate reaction to BL. However, there is still a debate on the optimal allergic workup to perform in children with a benign immediate reaction. In addition, management of children with severe cutaneous adverse drug reactions remains difficult. In this review, based on a selection of the most relevant studies found in the literature, we will review and discuss the diagnosis of different forms of BL allergy in children.
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Affiliation(s)
| | | | - Eva R Gomes
- Allergy Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mona Kidon
- Safra Children's Hospital and the Clinical Immunology, Angioedema and Allergy Unit, Chaim Sheba Medical Center, Tel Hashomer, Faculty of Pediatric Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Semanur Kuyucu
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Francesca Mori
- Allergy Unit, Department of Pediatric, Meyer Children's Hospital, Florence, Italy
| | - Ozge Soyer
- Department of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, Geneva University Hospital, Geneva, Switzerland
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19
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Nuñez-Borque E, Fernandez-Bravo S, Rodriguez Del Rio P, Alwashali EM, Lopez-Dominguez D, Gutierrez-Blazquez MD, Laguna JJ, Tome-Amat J, Gallego-Delgado J, Gomez-Lopez A, Betancor D, Cuesta-Herranz J, Ibañez-Sandin MD, Benito-Martin A, Esteban V. Increased miR-21-3p and miR-487b-3p serum levels during anaphylactic reaction in food allergic children. Pediatr Allergy Immunol 2021; 32:1296-1306. [PMID: 33876465 PMCID: PMC8453890 DOI: 10.1111/pai.13518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anaphylaxis is the most severe manifestation of allergic disorders. The poor knowledge of its molecular mechanisms often leads to under-diagnosis. MicroRNAs (miRNA) regulate physiologic and pathologic processes, and they have been postulated as promising diagnostic markers. The main objectives of this study were to characterize the human miRNA profile during anaphylaxis and to assess their capacity as diagnostic markers and determine their participation in the molecular mechanisms of this event. METHODS The miRNA serum profiles from the acute and baseline phase of 5 oral food-challenged anaphylactic children (<18 years old) were obtained by next-generation sequencing (NGS). From the panel of statistically significant miRNAs obtained, several candidates were selected and analyzed in 19 anaphylactic children by qPCR. We performed system biology analysis (SBA) on their target genes to identify main functions and canonical pathways. A functional in vitro assay was carried out incubating endothelial cells (ECs) in anaphylactic conditions. RESULTS The NGS identified 389 miRNAs among which 41 were significantly different between acute and baseline samples. The high levels of miR-21-3p (fold change = 2.28, P = .006) and miR-487b-3p (fold change = 1.04, P = .039) observed by NGS in acute serum samples were confirmed in a larger group of 19 patients. The SBA revealed molecular pathways related to the inflammation and immune system regulation. miR-21-3p increased intracellularly and in acute phase serum after EC stimulation. CONCLUSIONS These findings provide, for the first time, some insights into the anaphylactic miRNA serum profile in children and point to miR-21-3p and miR-487b-3p as candidate biomarkers. Furthermore, the SBA revealed a possible implication of these molecules in the underlying molecular mechanisms. Moreover, ECs increased miR-21-3p intracellularly and released it to the environment in response to anaphylaxis.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | - Pablo Rodriguez Del Rio
- Allergy Department, Foundation for Biomedical Research, Niño Jesus University Children's Hospital, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain
| | - Ebrahim Mohammed Alwashali
- CAI Genomics and Proteomics, Proteomic Unit, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - David Lopez-Dominguez
- Clinical Biostatistics Unit, Instituto de Investigación Puerta de Hierro (IDIPHIM), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Jose Julio Laguna
- Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | - Jaime Tome-Amat
- Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Centro de Biotecnología y Genómica de Plantas (UPM-INIA), Universidad Politécnica de Madrid, Madrid, Spain
| | - Julio Gallego-Delgado
- Department of Biological Sciences, Lehman College, City University of New York, New York, NY, USA.,Program in Biology, The Graduate Center, The City University of New York, New York, NY, USA
| | | | | | - Javier Cuesta-Herranz
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Dolores Ibañez-Sandin
- Allergy Department, Foundation for Biomedical Research, Niño Jesus University Children's Hospital, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain
| | | | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Faculty of Biomedicine and Medicine, Alfonso X El Sabio University, Madrid, Spain
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20
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Gaspar Â, Santos N, Faria E, Pereira AM, Gomes E, Câmara R, Rodrigues-Alves R, Borrego LM, Carrapatoso I, Carneiro-Leão L, Morais-Almeida M, Delgado L, Pedro E, Branco-Ferreira M. Anaphylaxis in children and adolescents: The Portuguese Anaphylaxis Registry. Pediatr Allergy Immunol 2021; 32:1278-1286. [PMID: 33774834 DOI: 10.1111/pai.13511] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 03/07/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaphylaxis is increasing at pediatric age; however, its characterization is hampered by underdiagnosis and underreporting. The aim of this study was to identify the causes of anaphylaxis in children and adolescents in Portugal, thus contributing to a better knowledge of its etiology, clinical manifestations, and management. METHODS During a 10-year period, a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 533 patients under 18 years of age with anaphylaxis were included. RESULTS Mean age was 8.5 ± 4.9 years, 61% were male; 45% had asthma. Mean age at the first anaphylaxis episode was 5.3 ± 4.7 years (ranging from 1 month to 17 years of age), 63% at pre-school age. Most reactions occurred at home (57%). Food-induced anaphylaxis was the leading cause (77%). The main culprit foods were cow's milk (32%), tree nuts (16%), shellfish (13%), egg (12%), fresh fruits (11%), fish (8%), and peanut (8%). Other causes included drugs (11%), insect sting (5%), cold-induced anaphylaxis (4%), exercise-induced anaphylaxis (2%), latex (1%), and idiopathic anaphylaxis (1%). Most patients (83%) were admitted to the emergency department; only 46% received adrenaline treatment. Recurrence of anaphylaxis occurred in 41% of the patients (3 or more episodes in 21%). An adrenaline autoinjector was used in 9% of the patients. CONCLUSIONS In the Portuguese pediatric population, food is the leading cause of anaphylaxis. Undertreatment with adrenaline and high recurrence of anaphylaxis highlight the need to improve both the diagnosis and the therapeutic management of this life-threatening entity.
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Affiliation(s)
- Ângela Gaspar
- Immunoallergy Department, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Natacha Santos
- Immunoallergy Department, Centro Hospitalar Universitário Algarve, Portimão, Portugal
| | - Emília Faria
- Immunoallergy Department, Centro Hospitalar Universitário Coimbra, Coimbra, Portugal
| | | | - Eva Gomes
- Immunoallergy Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rita Câmara
- Immunoallergology Unit, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | | | - Luís-Miguel Borrego
- Immunoallergy Department, Hospital da Luz Lisboa, Lisbon, Portugal.,CEDOC, Comprehensive Health Research Center (CHRC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Isabel Carrapatoso
- Immunoallergy Department, Centro Hospitalar Universitário Coimbra, Coimbra, Portugal
| | | | | | - Luís Delgado
- Immunoallergology Unit, Hospital CUF Porto and Instituto CUF Porto, Porto, Portugal.,Immunoallergy Department, Centro Hospitalar São João, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisa Pedro
- Immunoallergy Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal
| | - Manuel Branco-Ferreira
- Immunoallergy Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal.,Immunoallergology University Clinic, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
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21
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Tsabouri S, Atanaskovic-Markovic M. Skin eruptions in children: Drug hypersensitivity vs viral exanthema. Pediatr Allergy Immunol 2021; 32:824-834. [PMID: 33621365 DOI: 10.1111/pai.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/11/2022]
Abstract
Childhood rashes or exanthemas are common and are usually relatively benign. There are many causes of rash in children, including mainly viruses, and less often bacterial toxins, drugs, allergens and other diseases. Viral exanthema often appears while children are taking a medication in the course of a viral infection; it can mimic drug exanthema and is perceived as a drug allergy in 10% of cases. In the vast majority of cases, the distinction between virus-induced and drug-induced skin eruption during the acute phase is not possible. The drugs most commonly implicated are beta-lactams (BL) and non-steroidal anti-inflammatory drugs (NSAIDs). Viruses, commonly Epstein-Barr virus (EBV), human herpesvirus 6 (HHV6) and cytomegalovirus (CMV), and the bacterium, Mycoplasma pneumoniae, may cause exanthema either from the infection itself (active or latent) or because of interaction with drugs that are taken simultaneously. Determination of the exact diagnosis requires a careful clinical history and thorough physical examination. Haematological and biochemical investigations and histology are not always helpful in differentiating between the two types of exanthema. Serological and polymerase chain reaction (PCR) assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity. A drug provocation test (DPT) is although considered the gold standard for the diagnosis and is not preferred by the patients. Skin tests are not well tolerated, and in vitro tests, such as the basophil activation test and lymphocyte transformation, are of low sensitivity and specificity and their relevance is debatable. Based on current evidence, we propose a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous eruption while receiving a drug.
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Affiliation(s)
- Sophia Tsabouri
- Child Health Department, Medical School, University of Ioannina, Ioannina, Greece
| | - Marina Atanaskovic-Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,University Children's Hospital of Belgrade, Belgrade, Serbia
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22
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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23
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Sala‐Cunill A, Luengo O, Curran A, Moreno N, Labrador‐Horrillo M, Guilarte M, Gonzalez‐Medina M, Galvan‐Blasco P, Cardona V. Digital technology for anaphylaxis management impact on patient behaviour: A randomized clinical trial. Allergy 2021; 76:1507-1516. [PMID: 33043475 DOI: 10.1111/all.14626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Epinephrine is the first-line treatment for anaphylaxis. Patients at risk should always carry an epinephrine autoinjector (EAI). Several EAI gaps have been identified. We sought to evaluate satisfaction using a medical device (digital technology comprising an EAI smart case connected to a mobile APP) with functions that overcome most of the EAI limitations and to determine whether patient behaviour and anaphylaxis management improve with its use. METHODS This was a randomized, open-label, crossover clinical trial in a tertiary hospital involving patients with history of anaphylaxis carrying an EAI. The study was conducted in two three-month periods, one with and one without the medical device. The primary endpoint was satisfaction with the medical device. Usability, adherence, anxiety and anaphylaxis episodes were evaluated as secondary endpoints. RESULTS A total of 100 patients were included (mean age 38.1 years, 74% female), and 95 completed the trial. The satisfaction visual analogue scale (VAS) after using the medical device was higher than before its use (89.1 [95% CI, 60.2-99.1] vs 56.3 [95% CI, 48.1-81.4]; P < .0001). The adherence VAS improved from 59.7 (95% CI, 54.0-65.3) to 88.6 (95% CI, 84.2-92.9) (P < .0001). Overall, 90% patients found the medical device easy to use. Patients' anxiety decreased from 52.2% to 29.3% (P < .001). Seven episodes of anaphylaxis occurred during the study, all in patients without the medical device (P = .025). Eighty-eight per cent of patients felt more involved in the management of anaphylaxis when using the medical device. CONCLUSION This is the first clinical trial evaluating digital technology for EAIs, showing a change of behaviour in patients at risk of anaphylaxis, increasing satisfaction, improving adherence, and reducing anxiety, with good usability.
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Affiliation(s)
- Anna Sala‐Cunill
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- ARADyAL Research Network Institute of health Carlos III (ISCIII) Madrin Spain
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
- Adan Medical Innovation S.A Barcelona Spain
| | - Olga Luengo
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- ARADyAL Research Network Institute of health Carlos III (ISCIII) Madrin Spain
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
| | - Adrian Curran
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
- Adan Medical Innovation S.A Barcelona Spain
- Internal Medicine Department Vall d’ Hebron University Hospital Barcelona Spain
| | - Nuria Moreno
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- Vall d’Hebron Research Institute Barcelona Spain
| | - Moises Labrador‐Horrillo
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- ARADyAL Research Network Institute of health Carlos III (ISCIII) Madrin Spain
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
| | - Mar Guilarte
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- ARADyAL Research Network Institute of health Carlos III (ISCIII) Madrin Spain
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
| | | | - Paula Galvan‐Blasco
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- Vall d’Hebron Research Institute Barcelona Spain
| | - Victoria Cardona
- Allergy Section Vall d’Hebron University Hospital Barcelona Spain
- ARADyAL Research Network Institute of health Carlos III (ISCIII) Madrin Spain
- Vall d’Hebron Research Institute Barcelona Spain
- Autonomous University of Barcelona Barcelona Spain
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24
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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25
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Caubet J. Management of children with a suspicion of immediate drug hypersensitivity. Allergy 2021; 76:940-941. [PMID: 32715493 DOI: 10.1111/all.14521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
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26
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Atanaskovic-Markovic M. What is new in beta-lactam allergy in children? Pediatr Allergy Immunol 2021; 32:219-222. [PMID: 32955758 DOI: 10.1111/pai.13375] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/13/2023]
Abstract
This review highlights the novelties in understanding the underlying immunologic mechanisms of drug hypersensitivity reactions (DHRs) with special reference to beta-lactams (BLs) in the pediatric population, as well as tiny changes in clinical classification and diagnosis of DHRs, in the last couple of years. BLs are still the most commonly prescribed and used antibiotics in children. Viral infections are very often in children, and they can provoke skin rashes which are difficult to differentiate from DHRs. The majority of children are incorrectly labeled as "allergic." Therefore, allergy to BLs in children is overdiagnosed. These children often receive suboptimal treatment with second-line broad-spectrum antibiotics, which are less effective, more costly, and associated with an increased risk of antibiotic-resistant infections. This prolongs hospitalization and thus more uses health care. The correct diagnosis of BL allergy in children is still an important and hot topic. This review has outlined the need for correct diagnosis of BL allergy in children and all the controversies encountered by pediatricians and pediatric allergists. It is also necessary to change the paradigm.
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Affiliation(s)
- Marina Atanaskovic-Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,University Children's hospital of Belgrade, Belgrade, Serbia
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27
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Huang WY, Chiu TM, Kuo SF, Chung WH, Tsai YG. A Case Report of a 3-Year-Old Child With Anaphylactic Shock After a Diclofenac Suppository Confirmed by Serial Tryptase and a Basophil Activation Test. Front Pediatr 2021; 9:802715. [PMID: 35252076 PMCID: PMC8891597 DOI: 10.3389/fped.2021.802715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Diclofenac is one of the most commonly used non-steroidal anti-inflammatory drug (NSAID) agents for fever management by general practitioners. Anaphylaxis due to suppository of diclofenac sodium (Voltaren) is extremely rare in children. We report the case of a 3-year-old girl with anaphylactic shock after a diclofenac suppository with confirmation by serial tryptase and a basophil activation test.
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Affiliation(s)
- Wun-Yan Huang
- Department of Pediatric Emergency Medicine, Children Hospital, China Medical University, Taichung, Taiwan.,Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua City, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Su-Feng Kuo
- Department of Laboratory Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei and Linkou Branch, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yi-Giien Tsai
- Departments of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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28
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Bousquet J, Grattan CE, Akdis CA, Eigenmann PA, Hoffmann-Sommergruber K, Agache I, Jutel M. Highlights and recent developments in allergic diseases in EAACI journals (2019). Clin Transl Allergy 2020; 10:56. [PMID: 33292572 PMCID: PMC7712618 DOI: 10.1186/s13601-020-00366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022] Open
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. There was substantial progress in 2019 in the identification of basic mechanisms of allergic and respiratory disease and the translation of these mechanisms into clinics. Better understanding of molecular and cellular mechanisms, efforts for the development of biomarkers for disease prediction, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, entrance of new drugs in the clinics as well as recently completed phase three clinical studies and publication of a large number of allergen immunotherapy studies and meta-analyses have been the highlights of the last year.
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Affiliation(s)
- J Bousquet
- MACVIA-France, Montpellier, France. .,CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
| | - C E Grattan
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - P A Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - K Hoffmann-Sommergruber
- Depart of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland.,ALL-MED Medical Research Institute, Wrocław, Poland
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29
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Elst J, van der Poorten MLM, Faber MA, Van Gasse AL, Garvey LH, Bridts CH, De Puysseleyr LP, Mertens C, Hagendorens MM, Sabato V, Ebo DG. Mast cell activation test in chlorhexidine allergy: a proof of concept. Br J Anaesth 2020; 125:970-975. [DOI: 10.1016/j.bja.2020.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
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30
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Sobrino-García M, Moreno EM, Muñoz-Bellido FJ, Gracia-Bara MT, Laffond E, Doña I, Martín C, Macías EM, de Arriba S, Campanón V, Gallardo A, Dávila I. Analysis of the Costs Associated With the Elective Evaluation of Patients Labelled as Allergic to Beta-Lactams or Nonsteroidal Antiinflamatory Agents. Front Pharmacol 2020; 11:584633. [PMID: 33746738 PMCID: PMC7970755 DOI: 10.3389/fphar.2020.584633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Being labelled as allergic to different drugs results in patients receiving other treatments, which are more toxic, less effective and more expensive. We aimed to analyze different studies of the costs of drug hypersensitivity assessment. Methods: A bibliographic search on studies regarding this issue was performed, including the available scientific evidence up to June 2020. We searched three databases with terms related to costs and allergy testing in drug hypersensitivity reactions. Results: Our search revealed 1,430 publications, of which 20 met the inclusion criteria. In the manuscript, prospective studies evaluating the costs of the evaluation of patients with suspected allergy to beta-lactams or non-steroidal anti-inflammatory drugs are analyzed. Also, comment is made on the costs associated with incorrect labeling as non-steroidal anti-inflammatory drug or penicillin hypersensitivity. Conclusions: Taking all costs into account, the study of drug hypersensitivity is not expensive, particularly considering the economic and clinical consequences of labeling a patient with hypersensitivity to drugs.
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Affiliation(s)
| | - Esther M Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse Reactions (ARADyAL), Network for Cooperative Research in Health of Instituto de Salud Carlos III, Salamanca University Hospital, Salamanca, Spain
| | - Francisco J Muñoz-Bellido
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Maria T Gracia-Bara
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Elena Laffond
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Inmaculada Doña
- Asthma, Allergic and Adverse Reactions (ARADyAL), Network for Cooperative Research in Health of Instituto de Salud Carlos III, Salamanca University Hospital, Salamanca, Spain.,Allergy Service, University Hospital of Malaga, Malaga, Spain.,Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Cristina Martín
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Eva M Macías
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Sonia de Arriba
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Valle Campanón
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain
| | - Alicia Gallardo
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain
| | - Ignacio Dávila
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse Reactions (ARADyAL), Network for Cooperative Research in Health of Instituto de Salud Carlos III, Salamanca University Hospital, Salamanca, Spain
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31
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Pimentel-Hayashi JA, Navarrete-Rodriguez EM, Moreno-Laflor OI, Del Rio-Navarro BE. Physicians' knowledge regarding epinephrine underuse in anaphylaxis. Asia Pac Allergy 2020; 10:e40. [PMID: 33178565 PMCID: PMC7610080 DOI: 10.5415/apallergy.2020.10.e40] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Anaphylaxis is a life-threating hypersensitivity reaction. Epinephrine underuse in patients with anaphylaxis could lead to poor outcomes. There is evidence that the epinephrine use in such patients could be as low as 8%. OBJECTIVE To assess the percentage of physicians who know that epinephrine is the first-line treatment in anaphylaxis. The secondary objective was to assess knowledge gaps regarding anaphylaxis diagnosis and treatment that could lead to epinephrine underuse. METHODS We performed an online survey for physicians in Mexico City, using a 10-item questionnaire assessing anaphylaxis knowledge. We obtained measures of central tendency for statistical analysis, such as frequency, 95% confidence interval, as well as the chi-square test for comparing the groups. RESULTS A total of 196 surveys were considered for analysis. Of all the participants, 96.44% were able to correctly diagnose an anaphylaxis case with cutaneous, respiratory, and cardiovascular symptoms. Fifty-two percent correctly diagnosed anaphylaxis without cutaneous symptoms. The 72.4% of the respondents chose epinephrine as the first-line treatment, 42.3% correctly answered that there is no absolute contraindication to giving epinephrine, and 20.9% ignored whether there was any contraindication for its use. Only 38.3% of participants answered that during discharge they would prescribe an autoinjector. Regarding the administration route, 63.4% answered that the first dose of epinephrine is applied intramuscularly and 50% of the participants chose the correct dose of epinephrine. Only 2.6% of the participants answered all 10 questions correctly. CONCLUSION There is still some difficulty recognizing anaphylaxis without cutaneous symptoms. Even though two-thirds of physicians identified that epinephrine is the treatment of choice, only 49.5% would have used intramuscular epinephrine as first-line treatment. We found a low percentage of epinephrine ampule prescription and knowledge of the correct dose. These findings can account for epinephrine underuse when dealing with anaphylaxis in the real clinical practice.
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Affiliation(s)
- Joaquin A Pimentel-Hayashi
- Department of Allergy and Immunology, WAO Center of Excellence, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | - Elsy M Navarrete-Rodriguez
- Department of Allergy and Immunology, WAO Center of Excellence, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | - Oscar I Moreno-Laflor
- Department of Allergy and Immunology, WAO Center of Excellence, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | - Blanca E Del Rio-Navarro
- Department of Allergy and Immunology, WAO Center of Excellence, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
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32
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Kepil Özdemir S, Görgülü B, Doğanay Erdoğan B, Dursun AB, Göksel Ö, Öztürk AB, Işık SR, Bavbek S. Effect of drug desensitization on drug hypersensitivity-related quality of life. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1738-1741.e1. [PMID: 33186768 DOI: 10.1016/j.jaip.2020.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Seçil Kepil Özdemir
- İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Chest Diseases, Division of Allergy and Immunology, İzmir, Turkey
| | - Begüm Görgülü
- Ankara University School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey
| | | | - Adile Berna Dursun
- Recep Tayyip Erdoğan University School of Medicine, Department of Internal Medicine, Division of Allergy and Immunology, Rize, Turkey
| | - Özlem Göksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ayşe Bilge Öztürk
- Koç University School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, İstanbul, Turkey
| | - Sacide Rana Işık
- Yedikule Chest Diseases and Surgery Training and Research Hospital, Adult Allergy and Immunology Unit, Istanbul, Turkey
| | - Sevim Bavbek
- Ankara University School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Ankara, Turkey.
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33
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Tanno LK, Demoly P. Anaphylaxis in children. Pediatr Allergy Immunol 2020; 31 Suppl 26:8-10. [PMID: 33236416 DOI: 10.1111/pai.13336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
Anaphylaxis in children is a potential acute life-threatening systemic hypersensitivity reaction. Anaphylaxis fatality rate is estimated to be 0.65% to 2%. Food is the main anaphylaxis trigger in children, notably cow's milk, peanuts, and tree nuts. Mucocutaneous manifestations are observed in more than 90% of cases, but it is not essential for diagnosis. Deaths are rather secondary to the laryngeal edema, observed in 40%-50% of cases. Personal history of asthma, allergy to particular foods such as peanuts and tree nuts, and adolescence are known risk factors for anaphylaxis and more severe reactions. Epinephrine (adrenaline) is the medication of choice for the first-aid treatment of anaphylaxis. However, adrenaline auto-injectors (AAIs) are commercially available in only 32% of world countries. There are still considerable unmet needs in the field of anaphylaxis in children. Therefore, the Montpellier WHO Collaborating Centre aims to start the global action plan applied to anaphylaxis.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio-Libanês, São Paulo, Brazil.,University Hospital of Montpellier, Montpellier, France.,Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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34
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Tang MM, Fok JS, Thong BYH, Yun J, Li PH, Kang HR, Thien F, Yamaguchi M, Lucas M, Chang YS, Kim BK, Nagao M, Rengganis I, Tsai YG, Chung WH, Rerkpattanapipat T, Kamchaisatian W, Leung TF, Ho JY, Zhang L, Latiff AHA, Fujisawa T, Castells MC, Demoly P, Wang JY, Pawankar R. Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries. Asia Pac Allergy 2020; 10:e36. [PMID: 33178561 PMCID: PMC7610088 DOI: 10.5415/apallergy.2020.10.e36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries. OBJECTIVE To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI). METHODS A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020. RESULTS Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. In vitro-specific IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions. CONCLUSIONS There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.
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Affiliation(s)
| | - Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - James Yun
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Division of Medicine, Nepean Hospital, Sydney, Australia
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Center, Seoul National University Hospital, Seoul, Korea
| | - Francis Thien
- Eastern Health, Melbourne; Monash University, Melbourne, Australia
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Michaela Lucas
- Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Mizuho Nagao
- Allergy Center of Mie National Hospital, Tsu, Japan
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yi-Giien Tsai
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung and Linkou Branches, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Ticha Rerkpattanapipat
- Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Kamchaisatian
- Pediatric Allergy and Immunology Division, Samitivej Children's Hospital, Bangkok, Thailand
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Joo-Yoon Ho
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | | | | | - Mariana C Castells
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - Jiu Yao Wang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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35
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Sobrino M, Muñoz-Bellido FJ, Macías E, Lázaro-Sastre M, de Arriba-Méndez S, Dávila I. A Prospective Study of Costs Associated with the Evaluation of β-Lactam Allergy in Children. J Pediatr 2020; 223:108-113.e2. [PMID: 32532647 DOI: 10.1016/j.jpeds.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the costs associated with evaluation of β-lactam allergy in children labeled as allergic. STUDY DESIGN We performed a prospective year-long real life observational study designed to evaluate all pediatric patients with suspected β-lactam allergy who consulted for allergy evaluation. Direct and indirect costs were systematically recorded. Direct healthcare costs were calculated by taking into account the number of visits and all complementary and diagnostic tests performed. Direct nonhealthcare costs were calculated by considering the number of visits and the kilometers from their homes to the clinic. Finally, indirect costs were evaluated by considering the absenteeism of parents or other companions who took the children to the clinic. RESULTS A total of 40 children with suspected allergy to β-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct healthcare costs were $5038.03, with an average cost per patient of $125.95. Direct nonhealthcare costs reached $901.87 ($22.55 per patient) and indirect nonhealthcare costs reached $6384.35 ($159.61 per patient). The total cost was $12 324.25, a cost of $308.11 per patient. CONCLUSIONS Elective evaluation of β-lactam allergy and delabeling children who are not allergic is not expensive. In addition, it could save future expenses because of an unnecessary lifelong use of alternative antibiotics that are usually more expensive, less effective, and more frequently associated with antimicrobial resistance and different side effects.
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Affiliation(s)
- Miriam Sobrino
- Allergy Service, University Hospital of Salamanca, Spain
| | - Francisco J Muñoz-Bellido
- Allergy Service, University Hospital of Salamanca, Spain; Institute for Biomedical Research of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, Faculty of Medicine. University of Salamanca, Spain.
| | - Eva Macías
- Allergy Service, University Hospital of Salamanca, Spain; Institute for Biomedical Research of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, Faculty of Medicine. University of Salamanca, Spain
| | | | - Sonia de Arriba-Méndez
- Allergy Service, University Hospital of Salamanca, Spain; Institute for Biomedical Research of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, Faculty of Medicine. University of Salamanca, Spain
| | - Ignacio Dávila
- Allergy Service, University Hospital of Salamanca, Spain; Institute for Biomedical Research of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Biomedical and Diagnostic Sciences, Faculty of Medicine. University of Salamanca, Spain; Asthma, Allergic and Adverse Reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Salamanca University Hospital, Salamanca, Spain
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36
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Abstract
The drug allergy "label" may have a lifetime of consequences for a child. Many children with alleged drug allergies are proven to be tolerant to the culprit medication when challenged. The field of drug hypersensitivity is a recently evolving field of research, but studies on its epidemiology and diagnostic tools are lacking in children. Clinical history is significant in the diagnosis and classification of drug hypersensitivity in children. Diagnostic tools have been evaluated in a limited number of children; therefore, the guidelines are mainly in line with those for adults. Here, we review the clinical characteristics, main drugs, risk factors, and diagnosis of drug hypersensitivity to aid in its accurate diagnosis in children.
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Affiliation(s)
- Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Importance of Diagnostics Prior to Desensitization in New Drug Hypersensitivity: Chemotherapeutics and Biologicals. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00238-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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38
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Khaleva E, Franz A, Garvey LH, Jay N, Ylescupidez A, Bahnson HT, du Toit G. Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity. Pediatr Allergy Immunol 2020; 31:85-94. [PMID: 31518461 DOI: 10.1111/pai.13124] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative anaphylaxis (PA) in children is an uncommon but potentially life-threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes. METHODS We performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10 years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing. RESULTS Twenty-nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life-threatening hypotension was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 minutes (SD: 6, range: 1-25). The causative allergen was identified in 15 patients. CONCLUSION Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.
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Affiliation(s)
- Ekaterina Khaleva
- Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Medicine, MSc Allergy, University of Southampton, Southampton, UK.,inVIVO Planetary Health, Group of the Worldwide Universities, West New York, NJ, USA
| | - Amber Franz
- Seattle Children's Hospital, Seattle, WA, USA
| | - Lene Heise Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic Gentofte Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicola Jay
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Alyssa Ylescupidez
- Benaroya Research Institute and The Immune Tolerance Network, Seattle, WA, USA
| | - Henry T Bahnson
- Benaroya Research Institute and The Immune Tolerance Network, Seattle, WA, USA
| | - George du Toit
- Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Paediatric Allergy, King's Health Partners, King's College London, London, UK
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39
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Eigenmann P. Early wheeze progression to asthma, and insight into peri-operative anaphylaxis. Pediatr Allergy Immunol 2020; 31:5-6. [PMID: 31898367 DOI: 10.1111/pai.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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40
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Kim MJ, Shim DH, Cha HR, Kim CB, Kim SY, Park JH, Sohn MH, Lee JM, Kim KW. Delayed-Onset Anaphylaxis Caused by IgE Response to Influenza Vaccination. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:359-363. [PMID: 32009327 PMCID: PMC6997288 DOI: 10.4168/aair.2020.12.2.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/28/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022]
Abstract
Influenza vaccine-associated anaphylaxis is a very rare allergic reaction to vaccines, but the most concerning and life-threatening adverse reaction. Although the safety of influenza vaccines has been well documented, occasional cases of anaphylaxis in vaccinated patients have been reported. In this study, we analyzed the immunoglobulin E (IgE) response to whole influenza vaccines in a pediatric case of delayed-onset anaphylaxis after influenza vaccination. The patient showed elevated specific IgE levels against whole influenza vaccines, especially with split virion from egg-based manufacturing process. Specific IgE levels to influenza vaccines showed decreased over. We evaluated a causal relationship between influenza vaccine and anaphylaxis event by enzyme-linked immunosorbent assay. Delayed-onset anaphylaxis after influenza vaccination can occur in children without predisposing allergic diseases. In addition, the results suggested that formulation and production system of influenza vaccines could affect the probability of severe allergic reaction to vaccines.
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Affiliation(s)
- Min Jung Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Hee Shim
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ran Cha
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Bi Kim
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jeon Han Park
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Myun Lee
- Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Diaferio L, Giovannini M, Clark E, Castagnoli R, Caimmi D. Protocols for drug allergy desensitization in children. Expert Rev Clin Immunol 2019; 16:91-100. [PMID: 31771366 DOI: 10.1080/1744666x.2019.1698294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: When a drug hypersensitivity reaction is proven, desensitization protocols allow the reintroduction of the molecule in patients for whom such therapy is essential. Through drug desensitization (DDS), a temporary immune tolerance is maintained for the single course of a specific therapy. In pediatrics, indications for such a procedure include children with chronic diseases, severe infectious diseases and/or malignancies, who have a proven drug hypersensitivity.Areas covered: We ran a search on PubMed and Web of Science for papers on DDS and on DDS in children. Most protocols and recommendations on DDS focus on adults and have been adapted for children. The best candidates for desensitization are children with a history of immediate, IgE-mediated drug allergy, but this therapy may be applied also in nonallergic hypersensitivities and in non-immediate reactions. Most protocols in literature focus on antibiotics, especially beta-lactams, on chemotherapeutic agents, and on monoclonal antibodies.Expert opinion: Pediatric allergists should cooperate with specialists in infectious diseases and onco-hematology to provide DDS to children in need. Standardized protocols and international guidelines are still needed to optimize such treatment and to implement it in clinical daily practice.
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Affiliation(s)
- Lucia Diaferio
- Department of Pediatrics, Aldo Moro University of Bari, Bari, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Evangéline Clark
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France
| | | | - Davide Caimmi
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France.,Epidemiology of Allergic and Respiratory Diseases Department (EPAR), IPLESP, UMR 1136 INSERM - Sorbonne Université, Paris, France
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42
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Mayorga C, Fernandez TD, Montañez MI, Moreno E, Torres MJ. Recent developments and highlights in drug hypersensitivity. Allergy 2019; 74:2368-2381. [PMID: 31557314 DOI: 10.1111/all.14061] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management. Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication. Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs.
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Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Tahia D. Fernandez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Maria Isabel Montañez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Esther Moreno
- Allergy Unit Hospital Universitario de Salamanca‐ARADyAL IBSAL Salamanca Spain
| | - María José Torres
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Universidad de Málaga Málaga Spain
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43
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Eigenmann P. Local rhinitis needs allergen-challenges for diagnosis, late infancy supplementation of probiotics prevents eczema, and milk oral immunotherapy is effective in the long term. Pediatr Allergy Immunol 2019; 30:257-258. [PMID: 31032546 DOI: 10.1111/pai.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
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